General Question for the Week of September 12, 2016

General Compliance Question of the Week


I have heard that the Medicare “ICD-10 flexibilities” will expire on October 1, 2016. What does this mean exactly?


According to the Centers for Medicare & Medicaid Services (CMS), ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud. As you say, these ICD-10 medical review flexibilities will end on October 1, 2016, and providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. Note, however, that providers should already be coding to the highest level of specificity as this is not a new requirement.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.